PMID- 32832576
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220416
IS  - 2328-8957 (Print)
IS  - 2328-8957 (Electronic)
IS  - 2328-8957 (Linking)
VI  - 7
IP  - 8
DP  - 2020 Aug
TI  - Barriers to Adherence to Antimicrobial Stewardship Postprescription Review and 
      Feedback For Broad-Spectrum Antimicrobial Agents: A Nested Case-Control Study.
PG  - ofaa298
LID - 10.1093/ofid/ofaa298 [doi]
LID - ofaa298
AB  - BACKGROUND: Postprescription review and feedback (PPRF) is one of the most common 
      strategies in antimicrobial stewardship program (ASP) intervention. However, 
      disagreements between the prescribers and ASP personnel can occur. The aim of the 
      present study was to identify the factors associated with nonadherence to PPRF 
      intervention. METHODS: The present retrospective nested case-control study was 
      performed at a tertiary care center, which has been conducting a once-weekly PPRF 
      for carbapenems and piperacillin/tazobactam since 2014. Nonadherence to ASP 
      recommendations was defined as the failure of the primary care team to modify or 
      stop antimicrobial therapy 72 hours after the issuance of PPRF recommendations. 
      Factors associated with nonadherence to PPRF intervention were identified using 
      multivariate logistic regression analysis. RESULTS: In total, 2466 instances of 
      PPRF in 1714 cases between April 2014 and September 2019 were found. The 
      nonadherence rate was 5.9%, and 44 cases were found in which carbapenems or 
      piperacillin/tazobactam continued to be used against PPRF recommendations. 
      Factors associated with nonadherence to PPRF recommendations were a previous 
      history of hospitalization within 90 days (adjusted odds ratio [aOR], 2.62; 95% 
      confidence interval [CI], 1.18-5.81) and a rapidly fatal McCabe score at the time 
      of PPRF intervention (aOR, 2.87; 95% CI, 1.18-6.98). A review of the narrative 
      comments in the electronic medical records indicated that common reasons for 
      nonadherence were "the patient was sick" (n = 12; 27.3%) and "the antimicrobial 
      seemed to be clinically effective" (n = 9; 20.5%). CONCLUSIONS: Nonadherence to 
      PPRF recommendations was relatively uncommon at the study institution. However, 
      patients with a severe disease condition frequently continued to receive 
      broad-spectrum antimicrobials against PPRF recommendations. Understanding 
      physicians' cognitive process in nonadherence to ASP recommendations and ASP 
      interventions targeting medical subspecialties caring for severely ill patients 
      is needed to improve ASP.
CI  - (c) The Author(s) 2020. Published by Oxford University Press on behalf of 
      Infectious Diseases Society of America.
FAU - Takamatsu, Akane
AU  - Takamatsu A
AUID- ORCID: 0000-0003-2144-6653
AD  - Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, 
      Japan.
AD  - Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Tokyo, 
      Japan.
FAU - Yao, Kenta
AU  - Yao K
AD  - Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, 
      Japan.
FAU - Murakami, Shutaro
AU  - Murakami S
AD  - Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Tokyo, 
      Japan.
FAU - Tagashira, Yasuaki
AU  - Tagashira Y
AD  - Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, 
      Japan.
AD  - Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Tokyo, 
      Japan.
FAU - Hasegawa, Shinya
AU  - Hasegawa S
AD  - Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, 
      Japan.
AD  - Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Tokyo, 
      Japan.
FAU - Honda, Hitoshi
AU  - Honda H
AUID- ORCID: 0000-0002-4870-0730
AD  - Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, 
      Japan.
AD  - Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Tokyo, 
      Japan.
LA  - eng
PT  - Journal Article
DEP - 20200717
PL  - United States
TA  - Open Forum Infect Dis
JT  - Open forum infectious diseases
JID - 101637045
PMC - PMC7434090
OTO - NOTNLM
OT  - adherence
OT  - antimicrobial stewardship program
OT  - audit and feedback
OT  - broad-spectrum antimicrobials
OT  - postprescription review and feedback
EDAT- 2020/08/25 06:00
MHDA- 2020/08/25 06:01
PMCR- 2020/07/17
CRDT- 2020/08/25 06:00
PHST- 2020/03/26 00:00 [received]
PHST- 2020/07/13 00:00 [accepted]
PHST- 2020/08/25 06:00 [entrez]
PHST- 2020/08/25 06:00 [pubmed]
PHST- 2020/08/25 06:01 [medline]
PHST- 2020/07/17 00:00 [pmc-release]
AID - ofaa298 [pii]
AID - 10.1093/ofid/ofaa298 [doi]
PST - epublish
SO  - Open Forum Infect Dis. 2020 Jul 17;7(8):ofaa298. doi: 10.1093/ofid/ofaa298. 
      eCollection 2020 Aug.